MSII Chapt 19 Shock.txt

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MSII Chapt 19 Shock.txt
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MSII Chapt 19 Shock PP Book
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MSII Chapt 19 Shock and Book
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  1. What is shock?
    Inadequate tissue perfusion resulting in impaired cellular metabolism
  2. What does shock do?
    Deprives cells of essential oxygen and nutrients forcing cells to rely on anaerobic metabolism
  3. Shock is a result of what system?
    Cardiovascular
  4. What alterations in the cardio system exist with shock?
    Circulating blood volume, heart contractility, blood flow, vascular resistance
  5. Hypovolemic
    Inadequate blood volume to maintain the supply of oxygen and nutrients to body tissues
  6. Causes of blood/fluid loss
    hemorrhage, severe diarrhea or vomiting, excessive perspiration
  7. Excessive plasma shift can occur
    with burns, peritonitis, and intestinal obstruction
  8. Cardiogenic shock
    occurs when heart fails as a pump
  9. Most difficult shock to treat
    cardiogenic
  10. Obstructive shock
    Physical impairment of adequate circulating blood flow
  11. Causes of obstructive shock
    Tension pneumothorax, pericardial tamponade, PE, abdominal distension, aortic dissection
  12. Cardiac tamponade
    fluid collects within the pericardial sac causing compression of myocardium and resulting in reduced cardiac output and myocardial ischemia
  13. Superior vena cava syndrome
    obstruction of the superior vena cava resulting in facial or chest edema, SOB, tachycardia and hypotension
  14. Vasogenic/distributive shock
    improper distribution of blood due to excessive dilation of blood vessels ot decreased vascular resistance; fluid pools in dependent areas of body and is not returned to arterial circulation
  15. In what shock does plasma leak into interstitial compartment due to increased capillary permeability
    distributive
  16. Types of vasogenic/distributive shock
    anaphylactic, septic, neurogenic
  17. Most common cause of neurogenic shock
    spinal cord injury above the level of the first thoracic vertebra
  18. Neurogenic shock
    Disruption in the nervous system affects the vasomotor center in the medulla
  19. Signs and symptoms of neurogenic shock
    bradycardia with hypotension, pooling of blood in peripheral tissues with subsequent decreased venous return and cardiac output
  20. Causes of neurogenic shock
    injury or disease of upper spinal cord, spinal anesthesia, depression of vasomotor center from certain drugs
  21. Respiratory system shock effects
    tissue hypoxia and anoxia, respiratory failure, ARDS
  22. Acid-base balance shock effects
    metabolic acidosis
  23. Cardiovascular system shock effects
    myocardial depression, widespread clotting
  24. Neuroendocrine system shock effects
    release of epi and norepi, mineralocorticoids and ADH; decreased LOC
  25. Immune system shock effects
    depressed immune response
  26. GI shock effects
    decreased peristalsis, impaired liver function, death of intestinal submucosa
  27. Renal shock effects
    reduced filtration, inadequate renal perfusion, tubular necrosis
  28. Compensatory stage
    activation of baroreceptors in the carotid arteries and the aorta stimulate the sym NS with increased heart rate, constriction of peripheral vessels and reduced blood flow to the kidneys, lungs, muscles and GI
  29. Events in compensatory stage
    decreased renal blood flow triggers release of renin and angiotensin II, adrenal cortex secretes aldosterone which promotes sodium retention by kidneys; falling blood pH and increasing arterial CO2 detected by chemoreceptors in carotid arteries stimulate respiratory center; increase R and depth help to eliminate excess CO2 and normalize blood pH
  30. Symptoms in compensatory stage
    irritability, restlessness, increased P-may be thread or bounding, respirations increased rate and depth, decreased urine, cool and pale (warm and dry with septic shock), abdomen-decreased bowel sounds, increased blood glucose, thirst
  31. Progressive stage
    systemic circulation continues to vasoconstrict to try to maintain blood flow to vital organs; decrease in peripheral blood flow leads to weak or absent pulses, blood becomes more thick, cells lack oxygen and resort to anaerobic metabolism and produce lactic acid resulting in metabolic acidosis
  32. Symptoms in progressive stage
    listless, confusion, decreased BP, narrow pulse pressure, weak and thread pulses, tachycardia, disrhytmias, R increased, deep, crackles, T subnormal (except with septic), cold, pale clammy skin, cyanosis, dry mouth
  33. Irreversible/refractory stage
    irreversible changes as compensatory mechanisms fail; tissue perfusion deteriorates, death is imminent cerebral ischemia due to decrease in cerebral blood flow
  34. Symptoms of irreversible/refractory stage
    Loss OC, slow shallow R, cold clammy skin �cyanosis
  35. Tests that help establish type of shock
    blood and urine studies, measurement of hemodynamic pressure, chest radiograph, ECG, pulse OX, ABG, urine output
  36. Brain cells die after how long without O2
    4 minutes
  37. What might be ordered to decrease oxygen requirements
    paralytics, sedatives, analgesics
  38. What fluid replacement is ordered for shock
    normal saline intiallly;
  39. Crystalloids
    provide water replacement and electrolytes
  40. Colloids and example
    Albumin, remain in vascular system and draw fluid into the bloodstream
  41. Primary nursing dx for pt in shock
    altered tissue perfusion-assessment includes all body systems
  42. Systemic Inflammatory Response Syndrome
    generalized inflammation that threatens vital organs
  43. What conditions can lead to SIRS?
    Shock, multiple transfusions, massive tissue injury, burns, pancreatitis
  44. Diagnosis of SIRS
    T<97 or >100.4, HR>90, R>20 WBC<4000 or >12000
  45. Cardiogenic shock meds
    dopamine, dobutamine, noepi, epi, nitro, vasopressin
  46. Septic shock meds
    dobutamine, norepi, vasopressin
  47. Hypothermic suit
    maintains body at 33 C, may improve neurologic recovery after cardiac arrest
  48. Intraaortic balloon pump
    reduces preload with cardiogenic shock, heart pumps more efficiently, increases cardiac output
  49. External counterpulsation device
    pump applies pressure during diastole and relieves during systole, reduces preload
  50. Ventricular assist devices
    decreases myocardial workload and O2 demand; supports circulation until heart recovers or is replaced
  51. Extracorporeal membrane oxygenation
    blood is removed from inferior VC, oxygenated, and returned via femoral artery; used for short term stabilization
  52. All types of shock require fluid replacement except
    cardiogenic
  53. The basic cause of vasogenic shock is
    dilation of blood vessels
  54. What would explain massive edema in anaphylactic shock
    increased capillary permeability
  55. When patients lose plasma, what fluid is most appropriate for restoring blood volume?
    Crystalloid fluids
  56. Majority of cardiogenic shock are caused by
    MI
  57. Most common neurogenic shock
    spinal cord injury
  58. What is most likely to cause extravasation
    vasopressors
  59. First priority in treatment of shock from car accident
    get blood to brain

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